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Crowned Dens Syndrome More Common than Previously Thought, Say Researchers

Posted on: 12/13/2007
A disorder called crowned dens syndrome (CDS) is frequently given different names, resulting in the need to clarify the clinical features of the disorder. The authors of this study reviewed the records of 40 patients, aged 48 to 83, with the syndrome to evaluate the test findings and treatment outcomes.

CDS is characterized by the presence of calcium deposits around the odontoid process, the small area that sticks out from the second vertebrae of the neck; the first vertebrae rotates around the odontoid process. As the calcium builds up, it causes pressure and acute pain. The patients in this study had gone to the emergency room within 1 day of the onset of pain, which had spread to the both sides of the neck at the base of the skull. The patients scored their pain on the Visual Analog Scale , which rates the pain from 0 to 10, with 0 being no pain and 10 being the most severe. The average score was 8.3, ranging from 7.5 to 9.4). All patients had difficulty moving their necks.

Upon examination, all patients had an increase C-reactive protein level in their blood, an indicator of inflammation somewhere in the body, 10 patients had a higher than normal body temperature, and 13 patients had a slightly higher than normal white blood cell count. Patient histories showed that 22 patients had a history of pseudogout and 26 had a history of articular chondrocalcinosis .

X-rays did not show calcification in most patients, but the calcification was detected by computed tomography imaging, or CT scans. Twenty patients had calcium deposits in the posterior section, 11 around the posterolateral section, 5 had a circular pattern around the area, 2 in the front (anterior) and 2 patients had tuberous calcification masses on both sides.

The patients received either prednisolone (a corticosteroid), a non-steroidal anti-inflammatory (NSAID) or both for treatment. On average pain was relieved within 4 days, with some patients as early after 1 day of treatment, others as long as 9; the patients who took both medications did report quicker pain relief.

After an average of 9 months of follow-up, 9 patients relapsed and needed repeat treatment.

The authors point out that when they were reviewing records to find study subject, among all the patients who presented to the emergency with neck pain scores of over 7, 2/3 were ultimately diagnosed with CDS. They suggest that the syndrome is more common than originally thought, with the condition more common among elderly women.

They conclude that patients with CDS do have a good prognosis and treatment does effectively eliminate the pain within a few weeks.

Shinichi Goto, MD, et al. Crowned Dens Syndrome. In The Journal of Bone and Joint Surgery. December 2007. Vol. 89-A. Pp. 2732-2736.

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